Patient checklist

Duodopa is for the treatment of advanced levodopa-responsive Parkinson’s disease with severe motor fluctuations and hyperkinesia or dyskinesia when available combinations of Parkinson medicinal products have not given satisfactory results¹

Clinical indicators of advanced Parkinson’s disease

A consensus was developed with a panel of 17 movement disorder specialists from 10 countries and 15 indicators of suspected advanced Parkinson’s disease were developed^2*

Screening tool

Among the 15 indicators, 3 have been proposed as a screening tool – the 5-2-1 criteria:

• Taking at least 5 oral levodopa doses per day
• Having at least 2 hours of ‘OFF’ time per waking day
• Having at least 1 hour of troublesome dyskinesia per waking day

The presence of at least one of these indicators may be a sign of advanced Parkinson’s disease

Clinical indicators for device-aided therapy

The same group of experts refined the indicators further into 7 characteristics of people with advanced Parkinson’s disease that would
make them eligible for device-aided therapy such as Duodopa²

These criteria may act as a useful checklist when you are identifying patients that may be eligible for Duodopa therapy

The presence of any one of these indicators (except limited ADL, which would require the presence of another indicator) may indicate device-aided therapy eligibility²

Collaboration and teamwork are important

A collaborative and clearly structured multidisciplinary team (MDT) is key to optimal delivery of Duodopa³

Local practice may also determine the involvement of other healthcare professionals in the MDT⁴

Effective communication and collaborative decision-making can improve patient health and satisfaction while a failure to do so can adversely affect health outcomes 

Motivational interviewing can facilitate the trialogue between physicians, patients and care partners^5-7

Testing response to Duodopa before surgery

A temporary nasojejunal (NJ) tube could be considered, before a percutaneous endoscopic gastrostomy with a jejunal (PEG-J) tube
is placed, to determine whether the patient responds favorably to continuous drug delivery with Duodopa¹

The NJ tube delivers Duodopa directly to the jejunum, and this test phase may take approximately 5 days⁴

In a prospective study, 91.5% of patients who completed the NJ test phase progressed to PEG-J tube placement⁸

In cases where the physician considers this assessment is not
necessary, the NJ test phase may be waived and treatment initiated
directly with placement of the PEG-J¹

Overview of the PEG-J procedure

Initiating Duodopa therapy with the PEG-J procedure can be divided into five key steps:

1. Preparation

_{of the patient, including oral hygiene, antibiotic prophylaxis per institutional protocol, and placing them in a supine position⁹}

2. Placing the PEG tube

_{by identifying an appropriate puncture site, puncturing the stomach and inserting the puncture cannula into the stomach under
endoscopic control, inserting the guide thread, securing the PEG tube to the guide thread and pulling out through the abdominal wall
until the retention plate is in direct contact with the inner gastric wall, and securing the PEG tube⁹}

3. Attaching the Y-connector 

_{to the PEG tube¹⁰}

4. Positioning the intestinal J tube

_{by inserting into the Y-connector¹⁰}

5. Fixing the intestinal J tube to the PEG tube 

_{– the pump is connected and Duodopa treatment can start⁹}

Calculating and titrating the Duodopa dose

The Duodopa dose is composed of three individually adjusted doses providing continuous treatment for up to 16 hours.^1*
After initiation, fine adjustments of these three components of the overall dosage should be made over a few weeks to achieve an optimum dose¹

* Treatment is usually administered during the patient's awake period. If medically justified, Duodopa may be administered for up to 24 hours¹

Other routine measures for optimum pump management

ABBVIE CARE

[Placeholder for local affiliates to link to AbbVie Care services]